Hi there. I am insured with Blue Cross/Blue Shield Network Blue. I used my insurance for the first time in Jan. and I am very confused by the fees I had to pay two different physicians. The first physician charged me $197 and the second charged me $300, both were printed on the invoices as office deductibles. The second provider told me that BCBS would refund me when I questioned this charge. I e mailed BCBS, and was told that I was only responsible for $30 copay for the first and $15 copay for the second. They stated that they called the second provider and explained that I should not have paid $300 and that once the provider received the check from BCBS they would arrange a refund. Since they did not contact the first provider for me, I sent them a certified letter with copies of all correspondance with BCBS and a request for a refund, three weeks have gone by and I have recieved nothing. I also provided copies of all correspondance from BCBS to my second provider in person, a month has gone by and still no refund. The second provider also charged me $30 on two other occasions when it should have been $15. The last visit I had with them I was charged $15 only because of the paperwork I provided to them from BCBS. I am unable to call BCBS or my providers during business hours due to my job. I e mailed BCBS over a week ago to see if they could call these providers and explain their obligation to refund me, however, I have not heard back from them. Usually they responded to me after a couple days so I am thinking that maybe they will not get back to me. Now I am starting to think that maybe I was responsible to pay the $197 and $300. Is there such thing as an office deductible that a patient is responsible for even though they have insurance? I was going to send both providers certified letters but I want to make sure I have my information correct before doing so. If anyone could assist me I would greatly appreciate it. Thank you so much!

Some plans do have a deductible for all expenses, and some plans don't. You need to find out exactly what your plan benefits are. I suggest that you CALL BCBS and ask the customer service representative first what your plan entails regarding deductibles, and then ask him/her to call the providers to have the billing situation cleared up.

With your concern over your deductible and recieving a refund you really need to call your insurance carrier. You must get a lunch break or some break during the day. Talk to your employer... Human resources...explain to them the problem you are having and ask for some time during the day to call the insurance company. I would give up my lunch break to make that call.

foofla,

If you have an HMO, then you are responsible only for a co-pay that is spelled out in your contract...usually $10 or $20.
If you have an Indemnity type plan then you are responsible for some fraction (usually 20%) of the charge that BCBS acceps as reasonable and then the whole amount over that. Greedy doctors make plans like this a horrible choice for patients.

Ask your BCBC provider exacly what your responsibility is? If it's provided by work, see the plan administrator at your job. If it's a private plan and they dont get back to you, GET ANOTHER INSURANCE PLAN.

If you must call during the day, then call during the day...even if it means skipping lunch.

But you MUST find out what kind of plan you have.